Should ADHD medications be stopped during pregnancy?

With more Australians being diagnosed with attention deficit hyperactivity disorder (ADHD) than ever before, fresh research is shedding a light on its treatments and their impacts on pregnancy.
 
A new study from the University of Western Australia has investigated whether medications, such as dexamphetamine, should be stopped once a woman falls pregnant.
 
The paper said the safety associated with continuing or ceasing dexamphetamine during pregnancy had long been unclear, despite it being prescribed to rising numbers of women.
 
Adding that in the past, it has been generally recommended women cease taking the drug where possible when intending to become pregnant.
 
The investigation included 1688 women who had been dispensed dexamphetamine during pregnancy and gave birth between 2003 and 2018.
 
Around 550 continued to take dexamphetamine throughout pregnancy and were compared to about 300 who ceased before the end of the second trimester.
 
A third comparison group of more than 800 women, labelled the ‘unexposed’, were dispensed an ADHD medication prior to pregnancy, but not during.
 
‘Continuing dexamphetamine throughout pregnancy was not associated with an increase in adverse neonatal and maternal health outcomes compared to ceasing,’ the study concluded.
 
‘Ceasing dexamphetamine during pregnancy was associated with increased odds of threatened abortion compared with continuing dexamphetamine.
 
‘The unexposed showed some benefits compared to the continuers, suggesting that where possible the cessation of dexamphetamine prior to pregnancy may be advisable.’
 
These included decreased risk of pre-eclampsia, hypertension, postpartum haemorrhage, admittance to the special care unit, and fetal distress.
 
Lead author Dani Russell said the study’s results are reassuring.
 
‘Pregnancy can be a really stressful period for women with ADHD, so it is good to know that stopping their medication during pregnancy may not always be necessary,’ she said.
 
‘The results indicated that continuing to take dexamphetamine did not put women or their babies at increased health risks.’
 
Dr Ka-Kiu Cheung, Chair of RACGP Specific Interests Antenatal and Postnatal Care, told newsGP the study will be of comfort to expecting mothers.
 
‘It should be noted the study was retrospective in nature,’ she said.
 
‘Due to restrictions with sample size and the dataset analysed, it was not able to include information on the dose of medication taken, timing of medication cessation, and its impact on outcomes.
 
‘I would read the conclusions with this in mind and look forward to more research into this increasingly common issue.’
 
The research is part of a larger body of work investigating different treatments during pregnancy, and says further studies are now needed.
 
It comes amid ‘soaring’ rates of ADHD prescriptions, with some medications increasing in use by nearly 4450% in just two years.
 
Dr Cheung said the study highlights the importance of pre-conception or early pregnancy counselling, as well as medication management planning.
 
‘This is ideally coordinated by a woman’s GP, with input from their treating psychiatrist, obstetric physician, and antenatal pharmacist as appropriate,’ she said.
 
‘[GPs should] have regular conversations with women of a child bearing age who have additional medical conditions or who take regular medications about contraception and pregnancy planning.
 
‘Know your referral pathways for obtaining additional advice, whether it’s from private psychiatrists, perinatal mental health teams, obstetric physicians, or obstetric pharmacists.’ 
 
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ADHD antenatal care dexamphetamine pregnancy women’s health